Sociodemographic and environmental health risk factor of COVID-19 in Jakarta, Indonesia: An ecological study.

Since December 2019, the COVID-19 pandemic has rapidly emerged on a global scale. Many factors have influenced the spread of COVID-19. This research studies the sociodemographic and environmental health risk factors associated with COVID-19. The study used an ecological study design with subdistricts as its unit of analysis. The total population was 44 subdistricts. Data analysis used correlation and linear regression tests. The study results showed that the average COVID-19 incident rate in Jakarta is 99.8 per 10,000 population. Risk factors for the spread of COVID-19 were associated with population's high level of education (B = 3.094, p value<0.001), population density (B = 0.275, p value = 0.029), and slum area (B = 0.404, p value<0.001). The main risk factor for the spread of COVID-19 in Jakarta is high level of education, which can reflect a higher economic status to the population and a tendency to be more mobile. The government needs to enforce a mobility restriction to lessen the spread of COVID-19.

Early Initiation of ARV Therapy Among TB-HIV Patients in Indonesia Prolongs Survival Rates!

BACKGROUND: The HIV epidemic remains a public health problem with rising tuberculosis (TB) numbers around the world. Antiretroviral (ARV) therapy (ART) is essential to increase the survival of patients with TB-HIV coinfection. The aim of this study is to investigate the effect of ARV treatment initiation within TB treatment duration for the survival of patients with TB-HIV coinfection. METHODS: This is a retrospective cohort study of patients with TB-HIV coinfection and who were ARV naive from Prof. Dr. Sulianti Saroso Infectious Disease Hospital between January 2011 and May 2014 (N = 275). The Kaplan-Meier method, bivariate with the log rank test, and multivariate with the Cox regression were applied in this study. RESULTS: Cumulative survival probability of the patients with TB-HIV coinfection receiving ARV in a year was 81.5%. The death rate in patients with TB-HIV coinfection who received late ART initiation during TB treatment is higher by 2.4 times [adjusted hazard ratio (aHR) = 2.4, 95% confidence interval: 1.3-4.5, p = 0.006] compared with the patients who were in early ART initiation and were thereafter adjusted by the location of Mycobacterium tuberculosis infection. CONCLUSION: The effect of ART initiation is essential in the intensive phase (2-8 weeks) of anti-TB medication to increase the survival among TB-HIV coinfection group.

Factors associated with pasung (physical restraint and confinement) of schizophrenia patients in Bogor regency, West Java Province, Indonesia 2017.

BACKGROUND: Schizophrenia is a chronic mental disorder affecting more than 21 million worldwide. In Indonesia, 14.3% of households have a patient with a mental disorder, and the majority of these are in rural areas. Family members in Indonesia use repressive social measures like pasung (physical restraint and confinement) for these patients. A study was conducted with the objective to determine the factors associated with pasung among patients with schizophrenia in Bogor Regency, West Java Province, Indonesia 2017. METHODS: A case-control study was conducted in Bogor Regency from May-June 2017. A case subject was defined as a patient with schizophrenia who was ever subjected to pasung and a control subject was defined as a patient with schizophrenia residing in the same geographical area and never subjected to pasung. Multi-stage sampling was used to select case and control subjects from the registered reports of the Health Service of Bogor Regency (2012-16) in 34 sub districts and 59 health centers. Multivariate logistic regression was used to identify the factors associated with pasung. Attributable and population attributable risks (AR, PAR) for pasung were calculated. RESULTS: A total of 114 case and 136 control subjects were studied. Patient's aggressive or violent behavior (AdjOR: 4.49, 95%CI: 2.52-8.0), unemployment (AdjOR: 2.74, 95%CI: 1.09-6.9) and informal employment (AdjOR: 2.5, 95%CI: 1.1-5.84) in the family and negative attitude of the family towards the patient (AdjOR: 2.52, 95%CI: 1.43-4.43) were associated with pasung. Patient's aggressive or violent behavior (PAR = 44.3%) and unemployment in the family (PAR = 49.3%) were the predominant factors of pasung. CONCLUSIONS: Patient's aggressive or violent behavior, negative attitude of the family towards the patient and unemployment in the family were associated with pasung. We recommend health education and encouraging family members to shift patients with schizophrenia exhibiting aggressive or violent behavior to a mental health facility. Strengthening of basic mental health services and involving family members while treating patients with schizophrenia to develop positive attitudes could be considered. Creating employment opportunities and a social support system for treated patients with schizophrenia and family members could further avert pasung.

Perceptions about pasung (physical restraint and confinement) of schizophrenia patients: a qualitative study among family members and other key stakeholders in Bogor Regency, West Java Province, Indonesia 2017.

BACKGROUND: The UN resolution recommends treating all mentally ill patients with humanity and respect. However, social stigma continues to prevail for patients with schizophrenia. Physical restraint and confinement of the mentally ill is a well-known phenomenon in Indonesia and is termed as pasung. OBJECTIVE: To explore the perceptions of family members of patients of schizophrenia and other key stakeholders concerning pasung in Bogor Regency, West Java Province 2017. METHODS: This qualitative exploratory study was conducted in Bogor Regency, West Java Province from May to June 2017. This study involved 12 key stakeholders including family members, neighbors, community leaders, and mental health officers. In-depth interviews were conducted with family members (n = 3) who practiced pasung for patients with schizophrenia and key informant interviews of neighbors, community leaders (two household heads and one from a health cadre) (n = 3) and mental health officers of puskesmas (three midwives). Data triangulation was performed by interviewing residents and mental health workers. Content analysis was conducted and themes were identified based on valid inference and interpretation. RESULTS: Family members and society in general perceived that pasung is necessary for security reasons due to the patient's aggressive behavior such as physical violence to neighbors, stealing food etc. According to community leaders, families often do not respond to patient's request to be released from pasung. Family members had financial constraints to seek mental healthcare and were also dissatisfied with available services. Healthcare providers highlighted the poor knowledge and prevailing misconceptions about schizophrenia in the community. CONCLUSION: Concurrent efforts to strengthen basic mental health services and health education regarding schizophrenia, prevalent misconceptions, and importance of timely and appropriate treatment are needed, especially in rural settings.